Possible Overuse of PET to Detect Recurrence of Lung and Esophageal Cancers

Key Points

  • Use of PET varied from 0.05 to 0.70 scans per person-year for lung cancer and from 0.12 to 0.97 for esophageal cancer.
  • No difference in 2-year survival was observed for lowest- vs highest-use hospitals for lung or esophageal cancer.

Healy et al found that greater use of positron-emission tomography (PET) for detection of recurrence of lung and esophageal cancers was not associated with improved survival, suggesting potential overuse of the modality in this setting. They reported their results in the Journal of the National Cancer Institute.

Study Details

The study involved Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data on 97,152 patients with lung cancer and 4,446 with esophageal cancer diagnosed from 2005 to 2009, with follow-up through 2011.

Use of PET and Survival

For lowest- vs highest-use hospitals, use of PET was 0.05 (standard deviation [SD] = 0.04) vs 0.70 (SD = 0.44) scans per person-year for lung cancer and 0.12 (SD = 0.06) vs 0.97 (SD = 0.29) scans per person-year for esophageal cancer. Among patients undergoing PET, adjusted 2-year survival rates for lowest- vs highest-use hospitals were 29.0% (SD = 12.1%) vs 28.8% (SD = 7.2%) for lung cancer (P = .66) and 28.4% (SD = 7.2%) vs 30.3% (SD = 5.9%) for esophageal cancer (P = .55).

The investigators concluded: “Despite statistically significant variation in use of PET to detect tumor recurrence, there was no association with improved 2-year survival. These findings suggest possible overuse of PET for recurrence detection, which current Medicare policy [ie, limitation to three PET scans] would not appear to substantially affect.”

The National Institutes of Health, the Association for Healthcare Research and Quality, and the American Cancer Society supported this study.

Mark A. Healy, MD, of the Center for Healthcare Outcomes & Policy, University of Michigan, is the corresponding author of the Journal of the National Cancer Institute article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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